Athanassios Douzenis

Factors affecting hospital stay in psychiatric patients: the role of active comorbidity

BackgroundResearch on length of stay (LOS) of psychiatric inpatients is an under-investigated issue. In this naturalistic study factors which affect LOS of two groups of patients were investigated, focusing on the impact on LOS of medical comorbidity severe enough to require referral.MethodsActive medical comorbidity was quantified using referral as the criterion. The study sample consisted of 200 inpatients with the diagnosis of schizophrenia and 228 inpatients suffering from bipolar disorder (type I or II). Jonckheere and Mann–Whitney tests were used to estimate the influence of referrals on LOS, and regression analyses isolated variables associated with LOS separately for each group.ResultsHalf of the patients needed one or more referrals for a non-psychiatric problem. The most common medical condition of patients with bipolar disorder was arterial hypertension. Inpatients with schizophrenia suffered mostly from an endocrine/metabolic disease - 12% of referrals were for Hashimoto’s thyroiditis. A positive linear trend was found between LOS and number of referrals; the effect was greater for schizophrenia patients. The effect of referrals on LOS was verified by regression in both groups. Overall, referred patients showed greater improvement in GAF compared to controls.ConclusionsTo our knowledge this was the first study to investigate physical comorbidity in psychiatric inpatients using the criterion of referral to medical subspecialties. Comorbidity severe enough to warrant referral is a significant determinant of hospital stay. This insight may prove useful in health care planning. The results show lack of effective community care in the case of schizophrenia and negative symptoms may be the cause of this. Our findings call for more attention to be paid to the general medical needs of inpatients with severe mental health and concurrent severe medical comorbidity.

The Alcohol Use Disorders Identification Test (AUDIT): reliability and validity of the Greek version

BackgroundProblems associated with alcohol abuse are recognised by the World Health Organization as a major health issue, which according to most recent estimations is responsible for 1.4% of the total world burden of morbidity and has been proven to increase mortality risk by 50%. Because of the size and severity of the problem, early detection is very important. This requires easy to use and specific tools. One of these is the Alcohol Use Disorders Identification Test (AUDIT).AimThis study aims to standardise the questionnaire in a Greek population.MethodsAUDIT was translated and back-translated from its original language by two English-speaking psychiatrists. The tool contains 10 questions. A score ≥ 11 is an indication of serious abuse/dependence. In the study, 218 subjects took part: 128 were males and 90 females. The average age was 40.71 years (± 11.34). From the 218 individuals, 109 (75 male, 34 female) fulfilled the criteria for alcohol dependence according to the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV), and presented requesting admission; 109 subjects (53 male, 56 female) were healthy controls.ResultsInternal reliability (Cronbach α) was 0.80 for the controls and 0.80 for the alcohol-dependent individuals. Controls had significantly lower average scores (t test P < 0.001) when compared to the alcoholics. The questionnaires sensitivity for scores >8 was 0.98 and its specificity was 0.94 for the same score. For the alcohol-dependent sample 3% scored as false negatives and from the control group 1.8% scored false positives. In the alcohol-dependent sample there was no difference between males and females in their average scores (t test P > 0.05).ConclusionThe Greek version of AUDIT has increased internal reliability and validity. It detects 97% of the alcohol-dependent individuals and has a high sensitivity and specificity. AUDIT is easy to use, quick and reliable and can be very useful in detection alcohol problems in sensitive populations.

Involuntary admission in Greece: A prospective national study of police involvement and client characteristics affecting emergency assessment

Background and aim: Mental health legislation varies considerably from one country to the other. This study aims to describe the characteristics of the individuals who are brought in by the police for psychiatric assessment and the police involvement in this procedure in Greece. Method: Prospective study of the incident books of the police departments throughout Greece concerning involuntary psychiatric admissions. These books were completed by the police officers who brought the individuals for involuntary psychiatric examination. Results: In total, 2,038 involuntary assessments were evaluated and examined in relationship to the demographic characteristics of the examined individuals. The main findings are as follows. Males were more often assessed (69%) at a younger age than females (p < 0.001). The majority of the assessments led to involuntary admission (87.5%). Immigrant status did not lead to increased involuntary commitment. The chance for involuntary admission was greater for younger Greek nationals offering resistance. An unexpected finding is that police officers were unnecessarily present in almost half of the mental health assessments (49.4%). Conclusion: The psychiatrists in Greece who perform mental health assessments under the Greek Mental Health Law admit the majority of individuals. They also accept the presence of a police officer during the assessment more often than expected. This issue needs immediate addressing by means of better training and support of psychiatrists.

A short review on the aetiology and pathophysiology of alcoholism

Alcoholism is a chronic remitting and relapsing condition; its aetiology and pathophysiology remains largely obscure despite recent advances. This review summarises the current knowledge about the causation (biological or psychological) of alcohol addiction. This involves heredity, candidate genes, alcohol metabolism regulation and the influence of alcohol in the pathophysiology of the different neurotransmitter systems. Alcohol addiction is a multifactorial phenomenon where personality structure, individual state of mind and social influences are in constant interaction with brain neurobiology and pathophysiology. This disorder influences different sexes in different ways and causes major problems, especially in developed societies.

Descriptive and predictive validity of somatic attributions in patients with somatoform disorders: A systematic review of quantitative research

OBJECTIVE Research on hypochondriasis and other somatoform disorders (SFD) has provided evidence that patients with SFD tend to attribute their symptoms to organic dysfunctions or disease. However, recent studies appear to discredit this. There is no systematic evidence on whether patients with SFD predominantly rely on somatic attributions, despite calls to include somatic attributions as a positive criterion of somatic symptom disorder (SSD) in the upcoming Diagnostic and Statistical Manual of Mental Disorders (DSM-5). METHODS This study is a systematic review of quantitative studies which assess the descriptive and predictive validity of somatic attribution in SFD. The literature search was restricted to studies with patients who met the DSM-IV criteria for SFD. RESULTS Somatic attribution style in SFD has acceptable descriptive but insufficient predictive validity. This confirms that the overlap between somatic and psychological attributions is often substantial. Attribution style can discriminate between SFD patients with and without comorbidity. CONCLUSION A somatic attribution style does not qualify as a positive criterion in SSD. However, there is an urgent need for further research on causal illness perceptions in the full spectrum of medically unexplained symptoms in order to confirm this result. Given its high prevalence, research on psychological attribution style is warranted. Re-attribution does not provide a framework sophisticated enough to address the needs of patients in primary care.

Switching Suicide Methods in Order to Achieve Lethality: A Study of Greek Suicide Victims

This article focused on the relation between the method of last attempted suicide and the method used during the subsequent completed suicide. Using the method of psychological autopsy, the authors studied all suicide cases from the Athens Greater Area during a 2-year period. Twenty-four percent of the victims had history of previous suicide attempts. The majority of the suicide attempters switched to a different method (p < 0.001) for their final act. This difference is primarily due to the individuals who had chosen self-poisoning or wrist cutting in their last attempted suicide. Both of these groups switched to hanging or jumping from a height for their final attempt. Individuals who attempted suicide by hanging or jumping became completers using mainly the same methods.

Extrapyramidal side effects and suicidal ideation under fluoxetine treatment: a case report

BackgroundWe present the case of a 52-year-old woman with depression who developed extrapyramidal symptoms (mainly parkinsonism) and suicidal ideation while on fluoxetine.MethodsThe patient underwent neurological and neuroimaging examination.ResultsThe patients neurological and neuroimaging examinations were normal and there was no other cause of extrapyramidal symptoms. The patient showed remission of the aforementioned symptomatology when fluoxetine was discontinued.ConclusionsThis case shows that fluoxetine can be associated with extrapyramidal symptoms, and this may have an aggravating affect on clinical depression progress and the emergence of suicidal ideation.

Characteristics of immigrant suicide completers in a sample of suicide victims from Greece

Background: Immigrants have higher rates of suicidal behaviour in comparison to the indigenous population. Aims: To describe the characteristics of foreign nationality suicide completers and search for differences between them and native Greeks. This is the first study focused on immigrant suicide victims in Greece. Methods: Data were collected for all recorded cases of completed suicide for the two-year period November 2007 to October 2009 at the Athens Department of Forensic Medicine, the largest, by far, of its kind in Greece covering approximately 35% of the country’s population. The material was collected using the method of psychological autopsy as well as from the victims’ forensic records. Results: Nearly 10% of Greece’s 11 million population are of foreign nationality. Approximately half of them live in Athens and its suburbs, an area where 35% of Greece’s population lives. In our sample, 15.8% of the suicide victims were of foreign nationality (53 cases): 41 men (77.4%) and 12 women (22.6%). Higher suicide rates were found for citizens of Kuwaiti (9.1%), Somali (6.7%) and Afghan (0.9%) nationality (immigrant communities with very few members); the lower suicide rates were for individuals of Egyptian (0.01%), Ukrainian (0.01%) and Albanian (0.006%) nationality (the Albanian immigrant community is the largest in Greece). In comparison to their Greek counterparts, immigrant victims were younger (mean age 38.7 vs 54.9 years, p < .001) more often unemployed (p = .007) and with a history of alcohol abuse (p < .001). The main suicide method used by immigrants was hanging (p < .001) while for Greeks it was jumping from a height. Conclusions: Individuals who belong to small national communities seem to have the highest risk of dying by suicide. Immigrant suicide victims differ from the indigenous population in several parameters. Our data could help define the most vulnerable of them and apply more effective suicide prevention strategies.

Study of the association between MMPI and alcohol addiction type

Results The average age was 43,4 years ± of 8.1 and the years of education 10,7±:3,1. The average years of use were 20,08±9,10 and the average years of abuse were 8,03±6,31. For the whole sample the males surpassed the females in both parameters. Marital status: (28,6%) were single, (37,1%) married and (34,3%) divorced. There was negative family history for alcohol addiction in (57,1%) patients and (42,9%) had positive. Type of alcoholism: In (80%) it was type I and (20%) had type II. MMPI results: higher was the scale of psychopathy with an average 94,03 ±16, and the second scale schizophrenia with average 85,20±15,54. In the women the value in the introversion scale was smaller (44,28 vs 53.79 t test p<0.05 ). Patients (single and divorced) presented higher values in the scale of depression(65,77 vs 57,15 t test p<0.05). Positive heredity and the type of dependence did not differentiate the sample. The time of use was positively correlated with the Hypochondriasis, Depression, Histrionic as well as thee scales of Paranoia and Psychasthenia. The time of abuse was correlated with the psychasthenia scale (Spearman test p<0.05).The indicators of validity were within acceptable levels. The time of abuse was greater in the men that in the women.

Psychiatric Medication Intake in Suicide Victims: Gender Disparities and Implications for Suicide Prevention†

Frequency and gender differences of psychiatric medication intake in a sample of suicide victims from the Athens Greater Area were investigated with a particular focus on the implications for suicide prevention. Data were collected from the toxicological analyses of the suicide cases of the period November 2007–October 2009. Information was available for 262 individuals, 196 men (74.8%) and 66 women (25.2%); 109 of these (41.6%) were receiving psychiatric medication(s). Women were statistically more frequently under treatment: antidepressants (32.8% vs. 11.3%, p < 0.001), antiepileptics (9.1% vs. 0.5%, p = 0.001), antipsychotics (24.2% vs. 9.2%, p = 0.003), and benzodiazepines (16.7% vs. 6.6%, p = 0.024). Campaigns aiming to bring men with psychological difficulties in contact with mental health services and to lessen the stigma of mental illness, together with better training of nonpsychiatrists into “suspecting” “male” depression, could be particularly helpful for decreasing male suicides. More thoughtful choice of psychiatric medication could possibly already prevent a number of female suicides.